| NPI | 1972814820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN19083) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: FL 19083) |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2016-09-02 |